Taira Shogo, Nishihira Morikuni, Oba Kageyuki, Narayama Kohei, Yamauchi Akihiko
Department of Nephrology, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan.
Department of Cardiology, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan.
J Nephrol. 2025 Mar;38(2):725-731. doi: 10.1007/s40620-024-02026-2. Epub 2024 Jul 30.
We report a rare case of aortic valve thrombosis in a 55-year-old man. He had reduced urine output and generalized edema four days before admission. He felt sick and had chest pain on the day of admission. Severe hypoalbuminemia and massive proteinuria were present, and a diagnosis of nephrotic syndrome was made. An electrocardiogram showed findings suspicious for acute myocardial infarction, and emergency catheterization was performed. However, no coronary artery stenosis or occlusion was found at that time. A subsequent contrast-enhanced CT scan and transesophageal echocardiography revealed a thrombus in the aortic valve. The thrombus nearly occluded the left coronary artery. Emergency surgery was performed to remove the thrombus. His postoperative course was stable, but nephrotic syndrome persisted. A renal biopsy diagnosed minimal change disease. Treatment with 50 mg/day of prednisolone induced remission, and he was discharged on day 43. There were no aortic valve abnormalities. Nephrotic syndrome was considered the main contributor to thrombus formation. Aortic valve thrombosis associated with nephrotic syndrome is a very rare but potentially fatal condition that requires attention.
我们报告一例55岁男性主动脉瓣血栓形成的罕见病例。入院前四天，他尿量减少并出现全身水肿。入院当天，他感觉不适并伴有胸痛。存在严重低白蛋白血症和大量蛋白尿，诊断为肾病综合征。心电图显示有急性心肌梗死可疑表现，遂进行急诊导管插入术。然而，当时未发现冠状动脉狭窄或闭塞。随后的增强CT扫描和经食管超声心动图显示主动脉瓣有血栓。血栓几乎阻塞了左冠状动脉。急诊手术取出了血栓。他术后病情稳定，但肾病综合征仍持续存在。肾活检诊断为微小病变病。给予泼尼松龙50mg/天治疗后病情缓解，他于第43天出院。未发现主动脉瓣异常。肾病综合征被认为是血栓形成的主要原因。与肾病综合征相关的主动脉瓣血栓形成是一种非常罕见但可能致命的疾病，需要引起关注。
